Joint and muscle pain during breast cancer treatment

Joint and muscle pain can be a side effect of some breast cancer treatments.

Joint pain and hormone therapy

Joint pain is most commonly linked to hormone therapy.

The drugs most likely to cause joint and muscle pain are:

• Letrozole
• Anastrozole
• Exemestane

Joint and muscle pain can also be a side effect of other hormone therapies such as tamoxifen.

Other breast cancer treatments

Joint and muscle pain can also be a side effect of other breast cancer treatments like:

• Some types of chemotherapy
• Targeted therapies
• Growth factors, which you might have with or after chemotherapy to help your white blood cells recover
• Bisphosphonates

Different treatments can cause joint and muscle pain in different ways.

The pain can be mild and temporary for some people and more long term and severe for others.

You may feel pain in your hands, wrists and knees, but it can affect other joints too, like the hips or shoulders.

You might have stiffness in your joints, which can be worse first thing in the morning.

Rarely, you can develop other problems with your joints and muscles while taking hormone therapy, including:

• Carpal tunnel syndrome, where pressure on a nerve in the wrist can cause aching, pain, numbness and tingling in the hand and fingers, and difficulty gripping
• Trigger finger, where there’s pain and stiffness at the base of the affected thumb or fingers, and they may get stuck in a bent position. This is caused by swelling and inflammation in the tendons of the hand
• Tendonitis, where there’s swelling and inflammation of tendons in any of the joints, which can lead to pain, stiffness, difficulty moving, and a grating or crackling feeling when moving the tendon

Speak to your treatment team as soon as possible if:

• You’re concerned about the pain
• The pain becomes unmanageable
• The pain affects your sleep
• You have any changes in feeling, balance or mobility
• You’re finding it hard to do your daily activities

There are several ways to help manage pain.

Pain relief

You can take simple pain relief, like paracetamol or ibuprofen, to help joint and muscle pain.

Before using pain relief, ask your doctor or pharmacist about the correct dose, how long you should use it for and any possible side effects. This is especially important if you have any other medical conditions or take other medications.

If the pain does not improve, talk to your treatment team. They may be able to refer you to a doctor who specialises in pain management.

Exercise

Strength and flexibility exercises can help reduce joint and muscle pain.

You can talk to your treatment team about the best way for you to exercise. They may be able to refer you to a physiotherapist, who can suggest exercises to help your symptoms. They may also be able to tell you about exercise classes in your local area.

If you have secondary breast cancer, check with your treatment before starting any new type of exercise.

Strength exercises

Strength exercises use your own body weight or resistance to make your muscles work harder. Examples include:

• Lifting weights
• Using resistance bands
• Squats
• Push-ups
• Hill walking
• Heavy gardening, like digging

Flexibility exercises

Flexibility exercises are activities that can help your joints to keep moving and improve your symptoms so that you can do your daily tasks. Examples include:

• Yoga
• Stretching
• Tai Chi
• Pilates

Weight loss

If you’re overweight or living with obesity, losing some weight may help joint and muscle pain by reducing pressure on your joints.

If you want to lose weight, aim for a realistic weight loss of about 0.5 to 1kg (1 to 2 pounds) a week. You can do this by making small changes to your usual eating and exercise habits.

Try to:

• Eat a varied, balanced diet, following the Eatwell Guide
• Avoid keeping too many unhealthy snacks like sweets in the house – try popcorn, rice cakes or fruit instead
• Be active for 150 minutes a week – you can break this up, for example into 25-minute sessions
• Swap sugary drinks for water – you could add some sugar-free squash for extra flavour

It might help to get support from a local weight loss scheme or join an NHS weight loss programme. Your GP will be able to give you more information about programmes you might be eligible to join. And they may refer you to a specialist dietitian to help you make changes to your diet.

Self-help

You might want to try some self-help measures to help manage joint and muscle pain. These might include:

• Using heat or ice packs on the affected areas
• Paying attention to your posture, as good posture can reduce strain on your joints and muscles
• Taking regular breaks from sitting for a long time, for example if you work at a desk
• Trying to reduce stress and getting a good night’s sleep where possible
• Techniques like mindfulness and breathing exercises – ask your treatment team about any classes or groups in your local area or cancer support centre
• Trying a transcutaneous electrical nerve stimulation (TENS) machine, which uses a mild electrical current to relieve pain – check with your treatment team or GP first before trying one

Versus Arthritis has more information on different ways that you can manage joint and muscle pain.

Complementary therapies

Complementary therapies are used alongside conventional breast cancer treatments.

They include things like acupuncture, aromatherapy and herbal medicines.

There’s some evidence that acupuncture can help with joint and muscle pain.

Complementary therapies may also help you feel more relaxed and able to cope with the physical and emotional effects of breast cancer and its treatment.

Most complementary therapies are safe for people with breast cancer.

However, there’s conflicting evidence about the safety or effectiveness of some herbal products, and some may affect how certain cancer treatments work. Check with your treatment team or GP before using any herbal medicines.

Sometimes it can be difficult to know what’s causing your joint and muscle pain. For example, joint pain can also be a result of natural wear and tear on your joints as you get older or another condition like arthritis.

If your treatment team thinks your pain is a side effect of treatment, they may suggest a short break from treatment to see if your symptoms improve.

It’s important to speak to your treatment team before stopping any treatment.

Your treatment team may also suggest switching to another type of treatment or another brand of the same treatment to see if that helps your symptoms.

If there’s a brand you feel suits you best, you can speak to your treatment team or ask the pharmacist who dispenses your prescriptions if they can give you that brand.

Joint and muscle pain can be frustrating and upsetting, but you don’t have to go through it alone.

You can join our online forum and talk to people who are in the same situation – they may be able to offer tips and support.

You can also call our free helpline to talk through your concerns. See the bottom of this page for ways to get in touch.

You may also find our Moving Forward courses helpful. If you’ve come to the end of your hospital treatment, you’ll gain support from people with similar experiences and be equipped with the tools you need to move forward after primary breast cancer.

And if you’ve had a primary breast cancer diagnosis, Someone Like Me can match you with a volunteer who’s had a similar experience to you. They'll be a phone call or email away to answer your questions, offer support or simply listen.

If you have secondary breast cancer, you can find out about our Living with Secondary Breast Cancer support.